Since 1992, when the American Academy of Pediatricians made the recommendation for infants to be positioned on their sides or back for sleeping, to decrease the incidence of Sudden Infant Death Syndrome (SIDS), the occurance of deformational plagiocephaly has risen to estimates as high as 40% of healthy infants. Positional plagiocephaly is characterized by flattening of one side of the occiput, forward progression of the ear on the same side, and bossing of the ipsilateral forehead.

For those infants who do not make progress with therapy or positioning by three months of age, the prescription of a custom orthosis is recommended. At Boston Brace, we manufacture a cranial remolding helmet known as the Boston Band. We utilize a unique layering technique for our helmets which gives the Orthotist the ability to remove layers whenever necessary thereby allowing the infants head to grow in a normal fashion.

Protocol for Treatment

The following guidelines are provided to ensure that the identification of Plagiocephaly and the referral for treatment, are managed to provide optimal results for each patient.

· It is recommended that at three months of age, as a standard of practice, each child be evaluated and measured for cranial symmetry. Anthropometric calipers may be used for manual measurement taking.

· If it is determined that a cranial asymmetry of 8mm or greater is present, the child needs to be referred to a trained specialist in cranial remolding for treatment, care, and tracking of progress.

Treatment with the Boston Band

The treatment of plagiocephaly with a cranial remolding orthosis should commence at approximately 3 months of age. The Boston Band is a lightweight, plastic and foam orthosis made from a cast impression or a 3-D scan of the infant’s head. It is made of a plastic flexible shell lined with polyethylene foam. The foam can be modified over time to allow for growth and will provide a pathway for the infant’s head to grow into a more symmetrical shape. The Boston Band allows the baby to sleep in any position he or she wants, yet keeps pressure off the flat spots and constrains head growth along the axis of the prominent parts. It offers a simple and direct solution to the problem of positional plagiocephaly and brachycephaly. Correction usually occurs within 2 to 3 months for patients beginning Boston Band treatment at 3 months of age. In older patients, longer treatment time is necessary.

Dynamic Movement Orthoses are a relatively new approach to managing abnormal tone and neurological dysfunction. The aim is to improve functional abilities through the application of an orthosis designed to meet individual needs and objectives.

Each orthosis is made to measure to achieve a snug fit as it is believed that increased pressure on certain muscle groups and improved proprioception via the snug fit of the orthosis leads to better awareness of the affected part of the body.

The resistance created by additional layers of reinforcing material adds a biomechanical influence to the improvement in control of movement.

As well as improved function from better posture, improved proximal / distal stability and reduced involuntary movements; other benefits may include pain relief, decreased associated reactions, easier transfers and improved therapy sessions. Over time, the desired effect would be to experience the improvement in function and control of movement when the orthosis is removed i.e. carry over the effects experienced when wearing the orthosis. The onset of this carry over effect and the factors affecting its duration is dependent on the individual patient's presentation and reaction to the treatment.

Patients with neurological dysfunction as a result of cerebral palsy, stroke (CVA), head injury, multiple sclerosis and other neurological conditions may benefit from wearing an orthosis.

Compliance is an essential part of this treatment both for those wearing the orthosis and those caring for the wearer - i.e. parents, caregivers, teachers, and therapists. Without acceptance of the daily regime of donning and doffing the orthosis, treatment will not work. Wearing regime and washing instructions are supplied with each orthosis. It is important to remember that even though this type of treatment intervention has been in use for several years, there are still areas of this technique that need further research to substantiate some of the effects seen so far.

All orthoses should be prescribed by a rehab team which includes but not limited to a Physician, Orthotist and Therapist who have been trained & certified to assess, measure, fit & review the orthosis.

Benik Suit

Two-piece dynamic body vest is constructed of 3mm ventilated neoprene and is terry lined for comfort. Velcro® straps on the front half of the vest adhere to the Velcro®-sensitive material of the vest back.

Velcro straps at shoulders, sides and crotch provide for maximum adjustment. The orthosis provides upper trunk support and proprioceptive input.

The vest will provide warmth and added buoyancy during hydrotherapy and other water activities, but is NOT to be used as a life preserver.

Vest front available in all colors. Vest back available in Velcro.

SPIO Vest

Use:The SPIO vest is ideal for children with poor core muscle activation, stabilization, or weakness. Children with the diagnosis of Severe Axial Hypotonia, Athetoid Quadriplegia, Spinal Muscular Atrophy, or Benign Anterior Horn Cell Disease may benefit from the use of the SPIO vest.Provides shoulder-trunk-hip stability and mid-line orientation Increases body awareness Excellent trial orthosis To permit maximum freedom of movement in situations of neuromuscular scoliosis, the SPIO vest can also be used in conjunction with a very flexible custom molded Thoracic Lumbar Sacral Orthosis (TLSO)back to which the front portion can be attached and adjusted Vest is adjustable to provide optimal cylindrical chest, abdominal, and pelvic compression to assist core muscle activation and stabilization Great tool to assist with Hippotherapy treatmentFeatures:Standard double layer compression around the shoulder, trunk, pelvis, and hips front panel attaches to neoprene back with hook and loop tabs Shoulder extensions are individually adjusted for tension and angle of pull Worn down over the hips and anchored with a strap that fastens between the legs to prevent upward creeping on the trunk Sizes V54 and larger are made with removeable crotch strap/tab for toileting Back Panel is made of a semi rigid but flexible velcro-sensitive 1mm neoprene that adjusts to front portion with hook and loop tabs Neoprene back panel is perforated to reduce overheating.